Sun Coverage

The hour was late when an aide to Senate Majority Leader Harry Reid sent him the vote tally as the House passed its health care reform bill after a raucous Saturday night session.

Reid retires early and prefers not to take phone calls after 9 p.m. (unless the president is on the line). He got the breaking news on his BlackBerry shortly after 11:15 p.m.

The vote: 220-215.

In an instant, the majority leader typed a response: “That was close.”

And that was an understatement.

If a lesson can be learned from the House passage of the landmark $1.1 trillion health care reform legislation, it is just how difficult it will be for Reid to accomplish a victory in the Senate.

House Speaker Nancy Pelosi lost 39 of her 258 House Democrats on the final vote — even after she made concessions to conservative lawmakers, including strict anti-abortion language.

Reid does not have that margin of error. With Republicans in the Senate expected to put up a wall of opposition as those in the House did, Reid must count on every one of his Democrats and the two independents who work with his caucus to reach the 60-vote threshold to advance bills in the Senate.

Put another way: Pelosi lost almost one in seven of her lawmakers. But Reid cannot afford to lose one in 60.

As the health care debate moves back to the Senate, abortion, illegal immigration and questions about the rising costs of health care remain issues of high concern among Democratic senators.

Passage of the House bill was a tell-me-how-you-really-feel moment for many senators, who began outlining their conditions for supporting reform legislation.

Unlike rules in the House that limit the rights of individual lawmakers to force debate, the Senate does not offer that expeditious luxury — all 100 senators have the power to stop a bill in its path.

To open the debate, Reid needs the nod from 60 senators. He continues to consult with them one by one — “night and day,” as Assistant Majority Leader Richard Durbin of Illinois put it — to see what it will take to move forward.

“There’s a lot of people on the fence on this,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the main lobbying organization for 1,300 insurance companies.

While the insurance companies “are still committed to getting something done,” he said, the difficulties in the Senate are obvious.

“These tough issues are still out there,” he said. “Trying to craft a bill is a challenge.”

Advocates of health care reform saw in the House vote new momentum in the congressional debate. No previous attempt at health care reform in all the years Democrats have tried to advance the issue has gotten this far. Even reluctant House Democrats agreed to vote to move the process forward.

All eyes turned to Reid and the Senate this week as if something was about to happen.

“The basic underlying dynamic in the House vote was the historical imperative to pass this bill,” said Richard Kirsch, campaign manager at Health Care for America Now, an umbrella organization for groups advocating reform. “Even in the Senate, I think you’re going to see the same dynamic — a big imperative to deliver.”

But the Senate side of the Capitol works differently, with a slower pace that some see as infuriatingly incremental.

Even if Reid is able to bring the legislation to the floor next week to begin debate, as he hopes to do, Senate rules essentially thwart the quick action Pelosi enjoyed.

The House endured a long Saturday of health care debate, 9 a.m. to 11 p.m., but that time requirement pales in comparison to the weeks of debate that are about to unfold in the Senate.

Notably, Reid will be all but required to allow endless hours of discussion on amendments. Senators are preparing hundreds of amendments for consideration, a legislative cacophony — abortion, immigration, taxes, gun rights.

At every step of the way, the bill can be changed through the amendment process. With every alteration, the potential arises that the support of some senators will be gained or lost.

For example, Reid pledged to bring the bill to the floor with the government-run insurance option, the public plan, that liberals insist is needed to compete with private insurers and bring down the costs of premiums.

But conservative and moderate Democratic opponents of this plan see it, as Sen. Mary Landrieu of Louisiana does, as an unacceptable expansion of government. Some are considering alternatives, including the trigger option despised by liberals but suggested by Maine Republican Sen. Olympia Snowe that would require the public option only if insurance companies fail to make policies affordable to the uninsured.

Also consider abortion: For every senator who insists on strict abortion provisions like those the House included, there will be others insisting such provisions be blocked from any bill.

If anything is certain, it is that the House bill, even with its last-minute shift to the right on the abortion issue and reimbursement rates for doctors in the public plan, remains too liberal for the Senate’s more moderate and conservative members. This all but ensures the product that leaves the Senate will be dramatically different from the one that left the House.

And so Reid spends his days, behind the doors of his expansive office in the Capitol, talking with colleagues one by one to see what it will take to achieve consensus.

On Tuesday he was on the phone with Sen. Joseph Lieberman of Connecticut, who has said he would vote against the bill if it contains the public plan Reid has promised.

On Monday, Reid met with Sen. Ben Nelson of Nebraska, perhaps the most conservative Democrat in the Senate, a former state insurance director who opposes several aspects of the proposal and wants limits on federal money being used for abortion.

To reinforce the end goal of achieving President Barack Obama’s top policy priority by year end, Senate Democrats got a visit Tuesday from another party luminary. Former President Bill Clinton dropped by the senators’ weekly luncheon to remind them that if they fail to pass health care reform, their opponents will define the issue for them.

Emerging from the senators’ lunch, Clinton told reporters that he explained that passing health care reform was “an economic imperative.”